RECORD OF PROCEEDINGS

IN THE MATTER OF:	DOCKET NUMBER: BC-2017-00082

   	COUNSEL:  NONE

	HEARING:  NO

APPLICANT REQUESTS THAT:

The narrative reason for discharge on his DD Form 214, Certificate of Release or Discharge from Active Duty, be changed from “Adjustment Disorder” to a medical retirement. 

APPLICANT CONTENDS THAT:

A prior AFBCMR Board determined he could be eligible for a medical retirement effective 15 Apr 13 due to his medical condition. 

The applicant’s complete submission is at Exhibit A.

STATEMENT OF FACTS:  The applicant initially entered military service on 20 May 03. 

On 29 Dec 10, the applicant was diagnosed with an Adjustment Disorder, Depressed Mood. 

On 11 Apr 13, the applicant received an honorable discharge with a narrative reason for separation of “Adjustment Disorder.”

On 25 Jul 13, the Department of Veterans Affairs (DVA) issued a rating decision assigning the applicant a 70 percent disability rating for “Major Depressive Disorder (Adjustment Disorder with Depressed Mood),” effective 12 April 13.  

On 13 and 28 Jul 16, the AFBCMR deliberated Docket Number BC-2015-01367, and denied the applicant’s request to be reinstated to the grade of staff sergeant.  However, the AFBCMR Psychiatric Consultant recommended a permanent medical retirement with a 30 percent disability.  The Board disagreed with the recommendation for medical retirement, indicating the issue of a medical retirement was separate and distinct from the issue at hand, and would require review and comment by additional OPRs if the applicant should submit such a request to the Board. 

For more information, see the excerpt of the applicant’s record at Exhibit B and the advisories at Exhibits C and D.

AIR FORCE EVALUATION:

The AFBCMR Mental Health Advisor recommends granting the application.  The applicant was administratively separated for an Adjustment Disorder, which was considered to be a disqualifying condition, but not a condition eligible for a Medical Evaluation Board MEB.  For decades Adjustment Disorder has been listed in Air Force and Department of Defense (DoD) policies as a medical condition not considered a compensable disability by the military Disability Evaluation System (DES).  A recent revision of DoD policy [10 Apr 13] now acknowledges an individual with a Chronic Adjustment Disorder renders the individual eligible for processing via an MEB, while Acute Adjustment Disorder [that is a diagnosis initially made based upon an identifiable stressor, usually lasting no more than 6 months] continues to be held as non-compensable and non-ratable by the Military Departments.  

The Psychiatric Consultant is convinced that in three years of the applicant’s treatment, given all his complains and challenges, he met the criteria for another Axis I disorder.  In fact, at some point his psychiatrist documented the applicant had Anxiety Disorder.  Furthermore, on 14 Aug 12, during his initial appointment, the applicant complained of: poor sleep, low energy, poor concentration, anhedonia and “stressed” mood (which can be interpreted as depressed or anxious, but psychiatric note from May 11 clearly documents depressed mood).  This constellation of symptoms might fit the criteria for Major Depressive Disorder.  If one is to accept the diagnosis of an Adjustment Disorder provided by the military mental health specialists, it would be easy to determine that it lasted 3 years and, by DoD criteria, was Chronic. 

The new policy took effect on 10 Apr 13, so one can certainly see that under this new policy he was eligible for an MEB for the diagnosis of a Chronic Adjustment Disorder.  Had an MEB been conducted and referral made for a PEB review, the applicant's Chronic Adjustment Disorder more likely than not, been found unfitting.  Unintended procedural errors were made, and the applicant should have undergone an MEB.  The applicant’s level of disability would be consistent with the disability rating of 30 percent due to the occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).  

Recommend granting the applicant relief by changing his record to reflect he underwent an MEB, was found unfit by a PEB, with the assignment of a disability rating of 30 percent under VASRD code 9440, and was permanently disability retired, effective 15 Apr 12 (Sic).

The complete advisory is at Exhibit C.

The AFBCMR Medical Consultant recommends granting the application.  The applicant’s Enlisted Performance Reports (EPR’s) were consistently laudatory [“firewall 5’s”] for an extended period between 20 May 03 and 10 Dec 10.  However, on 29 Dec 10, the applicant was diagnosed with an Adjustment Disorder with Depressed Mood.  In addition, a subsequent undated and poorly legible print-copy of a Commander-Directed Mental Health Evaluation shows the applicant was given Axis I diagnoses (pl.) of Alcohol Abuse and Adjustment Disorder with Disturbance of Emotions and Conduct, with an Axis II diagnosis of Narcissistic Personality Disorder (with Histrionic Features). 

With respect to the applicant’s Adjustment Disorder, as explained in an advisory opinion by the Mental Health Advisor, such a diagnosis generally is limited to 6 months, under the Diagnostic and Statistical Manual (DSM)-IV; after which it should be either designated as Chronic, or a different more appropriate Axis I diagnosis is made.  In the case under review, the applicant carried the diagnosis of Adjustment Disorder for greater than 2 years, making this at least a Chronic Adjustment Disorder, or another appropriate Axis I diagnosis.  

A memorandum from the Assistant Secretary of Defense, dated 23 May 13, discusses management of Chronic Adjustment Disorder (CHAD) in the Disability Evaluation System.  The memo advises Military Departments to diagnose CHAD according to criteria published in the most current American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.  Specifically, the memo reads, IAW Paragraph 3.1 of [legacy] DoD Directive 1332.18, Separation or Retirement for Physical Disability, the Disability Evaluation System (DES) shall be the mechanism for implementing retirement or separation because of physical disability.  Military Departments may not discharge Service members due to inability to perform their duties, including ability to deploy, due to CHAD, except through the DES.  This guidance was effective 10 Apr 13, which means it applies to Service members on active service as of that date.  The applicant’s date of discharge was 11 Apr 13, after the CHAD policy implementation date. 

The Medical Advisor recommends consideration of compliance with the recommendation and rationale of the Mental Health Advisor, who opined the applicant’s “constellation of symptoms might also fit the DSM IV criteria for Major Depressive Disorder.”  The Mental Health Advisor also offered a sound rationale that retaining the diagnosis of Adjustment Disorder for such an extended period, made the condition Chronic and, thus, the applicant would have been eligible for processing via a MEB under the DoD policy guidance.  Finally, on or about 12 Jul 13, the applicant underwent a VA Compensation & Pension Examination for Mental Disorders.  He was given a diagnosis of Major Depressive Disorder, recurrent, moderate; which the reviewer opined “developed from his unresolved Adjustment Disorder.” 

The Medical Advisor recommends granting the applicant relief by changing the record to reflect the applicant underwent an MEB and was found unfit by a PEB, with assignment of a 30 percent disability rating under VASRD code 9440, Chronic Adjustment Disorder, and giving him permanent disability retirement, effective the date of his original discharge.

The complete advisory is at Exhibit D.

APPLICANT’S REVIEW OF AIR FORCE EVALUATION:

The Board sent a copy of the Air Force evaluation to the applicant on 5 Feb 18 for comment (Exhibit F), but has received no response.

THE BOARD CONCLUDES THAT:

1.  The application was timely filed.

2.  The applicant exhausted all available avenues of non-judicial relief before applying to the Board.

3.  After thoroughly reviewing all Exhibits, it is the Board’s opinion the applicant is the victim of an error or injustice.  The Board concurs with the rationale and recommendation of the AFBCMR Mental Health Advisor and Medical Consultant and finds a preponderance of the evidence substantiates the applicant’s contentions.  Therefore, the Board recommends the applicant’s records be corrected as indicated below.

THE BOARD RECOMMENDS THAT:

The pertinent military records of the Department of the Air Force relating to the APPLICANT be corrected to show that:

	a.  On 11 April 2013, the applicant was found unfit to perform the duties of his office, rank, grade, or rating by reason of physical disability, incurred while he was entitled to receive basic pay; that the diagnosis in his case was Chronic Adjustment Disorder, a condition which is rated at a compensable percentage of 30%, under Veterans Administration Schedule for Rating Disabilities (VASRD) code 9440; that the degree of impairment was permanent; that the disability was not due to intentional misconduct or willful neglect; that the disability was not incurred during a period of unauthorized absence; and that the disability was not received in the line of duty as a direct result of armed conflict or caused by an instrumentality of war.

	b.  He was discharged from active duty on 11 April 2013, and on 12 April 2013, he was permanently retired by reason of physical disability with a 30 percent compensable disability rating.

	c.  The election of Survivor Benefit Plan option(s), will be corrected in accordance with the member's expressed preferences and/or as otherwise provided for by law or the Code of Federal Regulations.

CERTIFICATION:

The following quorum of the Board, as defined in Air Force Instruction (AFI) 36-2603, Air Force Board for Correction of Military Records (AFBCMR), paragraph 1.5, considered Docket Number BC-2017-00082 in Executive Session on 11 Apr 18:

Panel Chair
Panel Member
Panel Member

All members voted to correct the record.  The panel considered the following:

Exhibit A:	Application, DD Form 149, w/atchs, dated 21 Dec 16.
Exhibit B:	Documentary evidence, including excerpts from official records.
Exhibit C: Advisory opinion, AFBCMR Mental Health Advisor, dated 3 May 16.
Exhibit D:	Advisory opinion, AFBCMR Medical Consultant, dated 16 Jan 18.
Exhibit E:	Notification of Advisory, SAF/MRBC to applicant, dated 5 Feb 18.

Taken together with all Exhibits, this document constitutes the true and complete Record of Proceedings required by AFI 36-2603, paragraph 4.11.9.